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Abstract:

Aim: To examine the multi-faceted menorrhagia complaint in terms of: subjective account of menstrual periods and symptoms, psychosocial measures, socio-demographic factors, and objective measurement of the menstrual loss. Study population: All women aged 25 to 49 years newly referred for menstrual problems to collaborating consultants at gynaecology clinics at Edinburgh and Glasgow Royal Infirmaries, and Glasgow Western Infirmary. Problems eligible for inclusion in the survey were excessive periods, period paid, premenstrual changes, ‘period problems’ (non-specific) and irregular periods. Only those with putatively heavy periods (referral for that reason, or subjective judgement) were invited to have their blood loss measured. Methods: Survey data were collected using the brief Clinic Questionnaire (ascertaining minimal essential data from as many as possible of the eligible clinic population); a more detailed Menstrual Evaluation Questionnaire; and the Menstrual Background Questionnaire (addressing contraceptive and obstetric history, and general health). The SF-36 quality-of-life questionnaire was also used. A Menstrual Chart was developed for the menstrual collection, and both total menstrual fluid loss and blood loss volume were measured. Results: The 952 women recruited were representative, in terms of age, socio-economic status and referral condition, of all 1506 eligible referrals. The 226 who had their menstrual loss measured were socio-demographically representative of all 865 women eligible for this stage. Case notes were found and reviewed for 665 (89%) of the 748 recruited early enough to be followed-up. The study sample is described in terms of socio-demographic factors, referral reasons, subjective report of periods, quality-of-life, well-being and clinic outcome, and for the relevant subset, menstrual loss volumes. Prior hypotheses with regard to associations between these factors are evaluated and reported. Methodological issues in menorrhagia assessment and measurement are considered. Conclusions: The current focus on volume of blood loss in menorrhagia complaint is unhelpful, since it ignores the associated symptoms and social disability that play a key role in leading a woman to seek help for her periods. The 80 ML criterion is of dubious clinical utility as it is neither sensitive nor specific for adverse impact of periods, compromised iron status, or pathology.